前路经腹腔一期病灶清除植骨融合内固定术治疗腰骶段脊柱结核  

PRIMARY ANTERIOR FOCUS DEBRIDEMENT AND BONE AUTOGRAFT WITH INTERNAL FIXATION VIA TRANSPERITONEAL APPROACH FOR TUBERCULOSIS OF LUMBOSACRAL JUNCTION

作　　者：肖联平[1] 江毅[1] 田永刚[1] 李晓东[1] 尹庆伟[1] 刘智[1] 韩立强[1] 福嘉欣[1] 

机构地区：[1]天津市第三中心医院骨科,天津300170

出　　处：《中国修复重建外科杂志》2009年第8期913-916,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结前路经腹腔一期病灶清除植骨融合内固定治疗腰骶段脊柱结核的临床疗效。方法2002年2月-2007年4月,采用经腹腔入路一期病灶清除,取2块大小为5cm×3cm的髂骨植骨及内固定治疗腰骶段结核16例,其中男4例,女12例;年龄27～63岁,平均38岁。病程6～18个月,平均10个月。均有不同程度腰骶部疼痛和结核中毒症状,9例伴下肢放射痛,3例鞍区麻木。2例曾按腰椎间盘突出诊治。结核受累节段均为L5、S1。血沉47～89mm/h,平均61mm/h。影像学检查诊断为脊柱结核。术前使用四联抗结核及营养神经支持治疗,待结核中毒症状改善或血沉呈下降趋势,肝、肾功能基本正常后行手术治疗。结果患者均安全完成手术,术中未出现腹腔脏器、大血管、马尾神经及输尿管损伤。术后切口均Ⅰ期愈合,结核无复发,无窦道形成。16例均获随访,随访时间12～37个月,平均21个月。无结核性腹膜炎、肠梗阻等并发症发生。4例男性患者均无勃起功能障碍、逆行射精等症状。术后3～6个月血沉恢复正常,定期复查X线片及CT,未见植骨块移位。患者术后12个月均获骨性融合,无钛板、螺钉断裂或松动发生。下肢放射性疼痛、鞍区麻木症状消失。仅有4例髂骨供骨区疼痛,2例轻度腰骶部疼痛,对症处理后疼痛缓解。按Chen等疗效评定标准:优14例,良2例。结论前路经腹腔一期病灶清除植骨融合内固定治疗腰骶段脊柱结核,可获得良好的骨性融合,重建脊柱稳定性。Objective To evaluate the clinical outcomes of primary anterior focus debridement, bone autograft, and internal fixation via transperitoneal approach in treating tuberculosis Of the lumbosacral junction. Methods From February 2002 to April 2007, 16 patients with tuberculosis of the lumbosacral junction underwent anterior radical debridement, autologous iliac bone graft （two pieces of iliac bone, 5 cm ×3 cm in size）, and internal fixation via transperitoneal approach, including 4 males and 12 females aged 27-63 years old （average 38 years old）. The course of the disease ranged from 6 to 18 months （average 10 months）. All patients experienced various degrees of pain in the lumbosacral area and toxic symptoms of the tuberculosis. Nine cases were complicated with radicular pain in the lower extremities, and 3 cases had saddle area anaesthesia. Two cases were initially diagnosed as lumbar intervertebral disc protrusion and treated accordingly. The segments involved by the tuberculosis were L5-S1 level in all cases. The average erythrocyte sedimentation rate （ESR） was 61 mm/hour. Imaging examination confirmed the diagnosis of spinal tuberculosis. All cases received four antitubercular drugs and nutrition support for nerve before operation. Operation was performed when hepatorenal function was normal, and the toxic symptom of the tuberculosis was under control or ESR was decreased. Results Operation was performed safely in all cases without injuries of abdominal viscera, major blood vessel, cauda equina nerve and ureter. All wounds healed by first intention. No recurrence of tuberculosis and formation of sinuses occurred. All cases were followed up for 12-37 months （average 21 months）. No such complications as tuberculous peritonitis and intestinal obstruction occurred. No postoperative erectile dysfunction and retrograde ejaculation occurred in the 4 male patients. ESR was recovered to normal 3-6 months after operation, and regular X-ray and CT exams showed no displacement of grafted bone. All pati

关 键 词：腰骶椎结核 前路 病灶清除 植骨 内固定 

分 类 号：R529.2[医药卫生—内科学] R687.3[医药卫生—临床医学]